Insurer Market Conduct Resources and Information | HAP

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Advocacy

State Oversight of Health Insurer-Provider Contracts

There are important health insurance market and delivery system issues that are developing across the commonwealth. In response, the state legislature is considering changes in state oversight of insurer and hospital contracts.

HAP believes there is a compelling public policy interest for the state to ensure that there is a competitive insurance market to enable broad access to coverage.

However, HAP opposes legislation that would result in a regulatory framework that either:

  • Prevents health care providers from being able to effectively structure contractual relationships with health plans
  • Unduly interferes with insurance market competition

Payor Practices Reform

 HAP supports House Bill 1194, sponsored by Representative Steven Mentzer (R-Lancaster), to protect against inappropriate use of prior authorization practices. That action leads to delays in patients receiving medically necessary care and creates significant administrative burdens for providers, which further detracts from patient care.

Additionally, inappropriate use of prior authorization has been shown to increase health care costs for businesses, consumers, and government payors, and also has a significant impact on quality of care. A survey of health care practitioners shows that 92 percent report prior authorization having a negative impact on patient clinical outcomes.

Related News

May 10, 2019

Week in Washington Included Movement on Drug Pricing, Protecting the ACA, Surprise Balance Bills

Health care coverage and associated costs took center stage in Washington, D.C. this week, with the U.S. Congress and Trump Administration working to advance policies to address drug prices, health care bills, and access to health coverage.  


May 01, 2019

PA Patients and Providers Rally Together for Prior Authorization Reforms

Yesterday in Harrisburg, HAP joined patients and other providers to introduce legislation reforming the insurance practice of requiring prior authorization for medical care. Unfortunately, current prior authorization processes can delay the timely delivery of appropriate, medically necessary care.


April 03, 2019

Federal Lawmakers and Stakeholders Aligned in Focusing on Protecting Patients from Surprise Balance Bills

Broad consensus continues to emerge regarding the need to pursue policy that will protect patients from surprise balance billing.


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